AF-AG - 46401SUMP PIIMP AGREEMENT
The City of Fridley hereby gives the property owner at /0302 _
-f-✓f�G�M�,v[/ � �� permission to install and connect the
residential sump pump discharge to the City's storm water drainage
system for a one-time connection fee of $200.00. The City will locate
the tie-in point. All other work associated with connecting to the
drainage system shall be the responsibility of the h�meowner.
' 1 GiC i�'� {( l��f c l�--L u A�LJ
Resldent yzme (Print)
Signature
%aa ��M�u� c t ;�
Address
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Telephone No. Date Paid
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